Preconception health in the well woman

Abstract

It is important to focus on preconception care in the well woman because prevention is better than treatment, and interventions commenced in pregnancy may have limited benefit. A lower socioeconomic status is associated with poorer maternal and neonatal outcomes, including gestational diabetes mellitus (GDM), preterm birth (PTB), pre-eclampsia (PET), and small-forgestational-age babies. Poor nutrition contributes to epigenetic dysregulation, which can alter gene expression and effect phenotypic change. A healthy diet during pregnancy, high in grains and vegetables, may help to reduce the risk of obesity, GDM, cardiovascular disease, hypertension, PET, and maternal anaemia; the benefits to the fetus include the prevention of low birthweight, macrosomia, PTB and stillbirth. The minimum amount of aerobic activity recommended during the preconception and pregnancy period is either 150 minutes of moderate intensity activity per week, or 30 minutes of activity per day, or 75 minutes of intense activity per week. Alcohol is a teratogen that can cause fetal growth restriction and facial malformations, learning and behavioural challenges and impairment to the central nervous system. Smoking in pregnancy can lead to impaired fetal growth and adverse effects on the immune system. Learning objectivesTo understand the importance of the preconception period. To evaluate key nutritional requirements in the preconception period. To critically evaluate the benefits and disadvantages of vaccination in the preconception period.

Pre-conception counselling

“…Being aware of modifiable risks, and the actions necessary to reduce these problems, helps empower patients to make changes. In addition, interventions started in pregnancy for risk factors such as obesity have limited impact; addressing these issues before conception may be more effective (Brooks et al., 2022; Linton et al. 2020; Stephenson et al., 2021).…”

“…2020; Stephenson et al., 2021). People whose health is optimised at the time of conception are more likely to go on to have a successful pregnancy and a healthy baby (Brooks et al., 2022). As well as lifestyle changes, some aspects of medical care, such as medication, may need to be changed.…”

“…The most sensible advice, therefore, seems to be a combination of dietary modification and increased physical activity. Advice on exercise is similar to the general population, though contact sports should be avoided (Brooks et al., 2022). Referral to weight management services may be appropriate, depending on local availability.…”

“…Being underweight is also associated with an additional risk of pregnancy complications (Brooks et al., 2022; NICE, 2023a). Such patients may benefit from specialist input, e.g.…”

“…NICE advises that anyone trying to conceive should take daily folic acid supplements, and continue these until the twelfth week of pregnancy (those with sickle cell disease, thalassaemia or thalassaemia trait should continue throughout pregnancy) (NICE, 2023a). World Health Organization guidance recommends folic acid supplementation for at least 3 months before conception (Brooks et al., 2022). People at standard risk should take 400 micrograms of folic acid, which is widely available without prescription.…”